DISEASES OF THE PERITONEUM. 



329 



cavity is dimiDished and the lung compressed. Finally, we find 

 other accessory alterations, causes or effects of ascites (alterations of 

 the heart, lungs, liver, etc. ; anemia, hydremia, cachexia). 



Symptoms. The principal symptom of ascites is the increase 

 in the size of the belly, becoming gradually more marked, but 

 sometimes taking place rapidly ; it is especially manifested in the 

 dependent portions of the abdomen ; the flanks become sunken, the 

 spinous processes are more prominent, and they appear to become 

 saddle-backed. In small animals the umbilical region is much 

 protruded. In the ox, the sheep (recently shorn), the dog, and the 

 cat, the abdomen forms a salient swelling back of the hypochondria* 

 The development of the belly, the saddle-back, sunken flank, and 

 general emaciation form quite a characteristic symptom -complex. 



The abdominal walls are flaccid above, and more or less distended 

 below; we perceive fluctuation on palpation. When applying the 

 hand upon one side of the abdomen and giving slight blows upon 

 the opposite side with the other hand, or if practised by the aid 

 of an assistant, we perceive swinging and undulating movements. 

 The same sensation is given by exploration of the abdomen through 

 the rectal walls. Spinola advises holding the hand in a vertical 

 position like an oar and having an assistant exert pressure upon 

 the opposite side. In applying the ear upon one side of the belly 

 while an assistant strikes slight blows upon the opposite region, we 

 perceive a chopping noise produced by waves of liquid, which are 

 broken against the abdominal wall. According to Spinola, this 

 same noise could be caused in small animals by abrupt blows upon 

 the body. We must not mistake for ascites a condition of repletion 

 in the stomach or intestine by water ingested in excess. 



In the regions where the ascitic serum is accumulated, percussion 

 gives a dull sound, unless it is performed with too much force, or 

 the liquid layer is too thin, or excessive pressure exerted upon the 

 area percussed expels the peritoneal liquid. The dulness found in 

 the inferior region of the abdomen is limited above, following a hori- 

 zontal line, above which we find a tympanic resonance. The dis- 

 placement of the dulness depending upon the different attitudes of 

 the patient is a very important symptom. When small animals are 

 kept in a posterior bipedal position we are surprised at the promi- 

 nence of the abdomen immediately above the symphysis ; at the 

 surface of this prominence percussion Bhows dulness which is also 

 limited upward, following a horizontal line. When placed in an 



